Posts Tagged ‘hypomania’

This post is inevitably going to be very long. I have been thinking about what to say for days now and I just haven’t been able to force myself to do it. I need to write though as I must get this straight in my head.

I seem to have writers block. I sit down here with the intention of writing and making sense of everything and I can’t do it. I try to put all of these thoughts down onto the screen and I can’t. There are too many conflicting worries. Too many fears. I know what I have to say, but I am scared. I am scared of writing for making it real.

As you may have read, there was talk about changing my diagnosis when I was first admitted. I was a little surprised and worried about this to say the least. It was hard enough getting a firm diagnosis the first time, let alone having to go through it again. I had accepted the Bipolar II diagnosis and was felt it was accurate. I’ve not found any other diagnosis that describes my experience as well, although I do accept there are so many overlaps between psychiatric diagnoses that it is possible to get things wrong or mixed up.

I am uncomfortable with the idea that Dr M seemed to decide I didn’t have Bipolar Disorder in about 10 minutes. She referred me to Dr S, who is a consultant psychiatrist specialising in psychotherapy. She’s involved with the EDT team that I have been waiting on since last year.

Dr S assessed me over two, hour long appointments. Dr M wanted someone with a therapeutic background to assess me and provide input on my diagnosis. Dr M was obviously considering a personality disorder, although amazingly it seems not the one I thought she was (BPD). I am starting to wonder though how much Dr M influenced Dr S’s assessment.

Dr S asked me about all sorts of stuff. We did the usual history thing and she dug deeper on some things. She asked me a lot about my mood. One thing I was uncomfortable with was the constant assertion that my experience of high moods, could just me not recognising normal moods because I spend so much time depressed. I don’t agree with this. It is not normal to be working 16 hours a day, hardly sleeping yet not tired at all, running around your office doing a million and one things, laughing and talking constantly and generally not being able to concentrate on anything.

At the end of our second session, she told me what she thought. She agreed that I had “some form of mood disorder” but wouldn’t commit to anything. She told me that she was leaning towards recurrent or chronic depression rather than Bipolar II disorder, but wouldn’t dismiss that completely. She also mentioned “personality traits” (mainly perfectionism and high standards) that she said perhaps made me more susceptible to mood episodes, but she also said she didn’t think there was enough to suggest a full personality disorder diagnosis.

So what did Dr M think? I tried to find out, but she kept avoiding the subject. With regards to mood, she did mention dysthymia at one point, but surely by definition dysthymia would never be severe enough for hospitalisation? There were times when she even questioned whether or not I was, or had ever been depressed, which seemed bizarre.

When asked about the personality side of things she said she “didn’t want to open any boxes that can’t be closed”, implying that it could be dangerous to give a diagnosis without being certain. She said there were personality traits which she was concerned about, particularly focussing on “high standards”, but she didn’t feel any were severe enough to consider a full PD diagnosis. She would also tell me that labels weren’t important and that we should focus on trying to “change the way I see the world”.

I saw Dr N a couple of weeks ago and he said my diagnosis had been changed on the system. This sparked my curiosity because I couldn’t get Dr M to commit to anything. I asked him what it said and he looked it up. It just said “moderate depression” and “personality disorder”. Nothing more specific than that. I think we were both curious as to what PD, although I think he suspected borderline too. After all, he had even suggested it back when he first met me, but it hadn’t been mentioned again since.

I saw Dr M again last week. We got through pretty much the whole appointment before I eventually found an opportunity and the courage to ask about my diagnosis. She had to look back through my notes to find it, which is a little scary. You would have thought she’d know what diagnosis she had given me.

It states clearly:

Moderate Depressive Episode

F 60.8 Other Specific Personality Disorder.

I have issues with the first diagnosis, but didn’t express them because I was so surprised and concerned about the second point. I didn’t know what F60.8 actually said, so I asked her what PD she referred to and she mentioned Narcissistic, which I was surprised about. Of all the PDs I had considered she might give, it was not that one. I told her this and she just said that she “felt the signs were there” and that Dr S agreed with her. I told her what Dr S had said to me; that there were some unhelpful personality traits and that I accepted those, but also that either of us didn’t think any constituted a full personality disorder diagnosis. Dr M then tried to justify her decision by saying it was not the primary diagnosis, but that if she thought it was there it should be documented. Somehow she seems to have decided to open the box after all.

I wanted to question how helpful any personality disorder diagnosis would be, let alone an inaccurate one, considering there aren’t any specialist services or extra treatment available here, but we had already gone well over my time and I didn’t have the fight or words to argue.

I want to argue though. I want to fight. The more I have read and the more I think about it, the more unhappy I am about this diagnosis. It doesn’t seem accurate and really doesn’t seem helpful.

I am less concerned about the depressive episode diagnosis, although that has its problems, but the personality disorder diagnosis is really concerning me. I find myself offended and ashamed by it. No one wants to be considered self-serving, unempathetic and arrogant. I think the shame has actually been one of the barriers to posting about it. I don’t even want to put my name near the diagnosis I’m so unhappy about it. The fact it is written in my notes for posterity is disconcerting to say the least.

So what is wrong with this diagnosis?

Firstly “Moderate Depressive Episode”.

If you consider the ICD-10 explanation of this diagnosis, F32.1, you have to note that by referring to a depressive episode you are implying that it is the first episode of depression. For me this is far from the case and I don’t like that my diagnosis neglects to consider any past mood episodes. It is almost as if she doesn’t believe I have been depressed before.

I also question the severity, but I understand that this can be subjective. Many people would go off my BDI score, which is still above 40 (severe depression is considered 30+). I do have more than four of the ICD-10 listed symptoms, but I would also suggest that some of these symptoms are marked and distressing, making it severe. Actually attempting suicide would surely put the suicidal ideation into distressing territory? Worthlessness, guilt etc are all pretty marked too. The thing is I still function reasonably well so people can be forgiven for thinking I am better than I am. It also doesn’t matter. The treatment for a moderate episode varies little from a severe one and it doesn’t make much difference whether it is my first episode or 10th.

What about the lack of acknowledgement of hypomania or high mood? The treatment for Bipolar II Disorder is different to that of Major Depression. I have responded much better to the introduction of Lamotrigine as a mood stabiliser than I did to any antidepressant to date. What if they try to take me off this? Would I respond better to a different one and will they ever try it? Usually antidepressants make me agitated and unstable. I have been okay with the Reboxetine so far, but it doesn’t seem to have lifted my mood at all, so what will happen if they change it? What if I am given an antidepressant that sends me skyward? It worries me.

At the end of the day though I am depressed at the moment and that’s the important thing. It’s the other diagnosis I’m most concerned about.

So – F60.8 “Other Specific Personality Disorder” (Narcissistic).

The ICD-10 does not give individual diagnostic criteria for the disorders listed in this category, so I will assume that the DSM-IV criteria is what Dr M is referring to, after all she had a copy of the DSM on her desk when I saw her.

The criteria for Narcissistic Personality Disorder is as follows:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

requires excessive admiration

has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

is often envious of others or believes others are envious of him or her

It is also a requirement in the ICD-10 that any specific personality disorder diagnosis meets the general diagnostic criteria for personality disorders.

According to ICD-10, the diagnosis of a personality disorder must satisfy the following general criteria, in addition to the specific criteria listed under the specific personality disorder under consideration:

There is evidence that the individual’s characteristic and enduring patterns of inner experience and behaviour as a whole deviate markedly from the culturally expected and accepted range (or “norm”). Such deviation must be manifest in more than one of the following areas:

cognition (i.e., ways of perceiving and interpreting things, people, and events; forming attitudes and images of self and others);

affectivity (range, intensity, and appropriateness of emotional arousal and response);

control over impulses and gratification of needs;

manner of relating to others and of handling interpersonal situations.

The deviation must manifest itself pervasively as behaviour that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e., not being limited to one specific “triggering” stimulus or situation).

There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behaviour referred to in criterion 2.

There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.

The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from sections F00-F59 or F70-F79 of this classification may coexist with, or be superimposed upon, the deviation.

Organic brain disease, injury, or dysfunction must be excluded as the possible cause of the deviation. (If an organic causation is demonstrable, category F07.- should be used.)

I guess you can draw your own conclusions from reading the criteria and what you know of me from reading here. I guess others may have a different opinion of me, but I hope they can see that this is not what I am like.

I have decided to go through each point of the NPD criteria myself to see if I can work out what does and doesn’t fit.

1. Self Importance

has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

I really don’t think this is the case. I often downplay my achievements, because I can actually find it hard to admit them, even recognise them. I was bullied at school for being clever and a “swot”, so I am not really comfortable with admitting my successes to people. Yet when I’m assessed by mental health professionals I do of course have to talk about my achievements and talents, so I guess they can be forgiven for not realising this. It’s hard not to talk about these things when you are asked to give your life story. I have a good job, which I have been successful in, I got a 2.1 at university, I got 3 As at A Level, I got 11 GCSEs including 4A*s and 4As. These are facts though, not exaggerations.

I don’t believe I am superior, certainly not to anyone with equivalent achievements. Most of my colleagues at work have a similar background to me and I certainly don’t consider myself superior to them. Yes, my academic record is superior to someone who left school with 3 Cs at GCSE, but that doesn’t make me superior; just better at school.

I think this is hard when you have been generally successful. You can seem like you are bragging when you are not, it’s just the truth. I remember during the assessment with Dr S there was a lot of focus on my achievements and suggestions that considering my age I had done well. I generally agreed with her, but now I almost wonder if she was fishing for this.

2. Grandiose Fantasies

is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

I don’t even believe in unlimited success or ideal love so how I can be preoccupied by fantasies of these things, I don’t know. When Dr M and Dr S had been talking about high standards, they actually seem to mean in this sense, rather than the perfectionist sense, which I didn’t realise until this diagnosis was made. So I’ve been agreeing with them when I actually disagree. They seem to think I expect to be highly successful and powerful. I don’t. In the past I had been fairly ambitious, expecting to do well at school and going on to get a good job, but I don’t expect “unlimited success”. Anyone with a good academic record starting out on a career similar to mine has similar expectations. This is usually something to be considered positive and not out of the ordinary. Now of course I’m depressed and even the most simple tasks seem ambitious, which would suggest that these thoughts aren’t pervasive either, therefore not meeting the diagnostic criteria.

There was a short period fairly recently where I had thoughts of going into politics as I wanted to make a difference and there was a lot of focus on diversity in politics and increasing the number of women in parliament. I can be passionate about issues and want to do something about them. I guess I may have been fantasising a little at the time, but even still this is not an unrealistic ambition. I have been interested in politics for years and often considered it as a future career option, but not because I want to be all powerful.

I have had the odd grandiose moment when my mood has been high though and I have admitted this. Of course they question whether or not I’ve ever experienced hypomania, so will put this down to personality rather than symptoms of a mood disorder.

3. Special Status

believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

This is one that I guess I can identify with, although I am not sure it is correct. I do not believe I am special as such, but I guess I do feel more comfortable with people that have a similar background or interests to me. I think everyone does though to some degree and it is not like I will not associate myself with other people. I try to judge people on their merits and will talk to anyone.

I can see why they may think this is true though. During my assessment with Dr S she asked me about my regrets regarding me degree choice. She asked about how I chose my course and one of my considerations was choosing a respected university. This consideration was mainly to keep my career options open as opposed to anything else. There are plenty of graduate employers that only recruit from top universities. I guess this could be seen as wanting to be associated with “high-status institutions” though, so they may well use this as an example when diagnosing me.

4. Admiration

requires excessive admiration

Erm. I don’t know how to reply to this. I cannot deny I can have difficulty responding to criticism and that I like praise, which I guess may come under this category, but I don’t require or seek excessive admiration. If someone likes me that’s a bonus, but if they don’t then fine.

5. Entitlement

has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

A sense of entitlement? I expect fair and reasonable treatment, but I don’t expect favourable treatment over others. I am a strong believer in equality and a sense of entitlement would go directly against this.

I can at times be stubborn and this could be misconstrued as expecting compliance with my expectations. I will compromise, but I try to be assertive as well. I don’t see this as entitlement though. We are usually encouraged to be assertive when in therapy, so it would be wrong to judge this as being narcissistic.

6. Exploitative

is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

It is criteria like this that makes me so uncomfortable about this diagnosis. I don’t want to be considered self-serving. I don’t take advantage of others in order to get ahead and I find it horrible when people do. Some of examples given are things such as dressing provocatively to get your own way. Ignoring the fact that if I dressed provocatively people would run to the hills, I would never do this. I hate the idea on too many levels.

7. Lacking Empathy

lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

There are two sides to this for me. In many ways I am often considered too empathetic. I consider other people’s needs often to the detriment of my own. I was told off repeatedly by the therapists at The Priory for considering everyone else first, for listening to the others and offering them advice and support, but for not giving myself the opportunity to speak and receive that support back. I would like to think that I understand how others feel and that I am sensitive to their needs. I certainly try to be, so I am not unwilling.

Yet, I know occasionally my bloke finds I have a lack empathy towards him. He says I don’t realise how much the things I say and do hurt him or recognise how he is feeling. I think our relationship is an isolated case though, because there are many ways in which I act different with him than I do with others – lack of assertion is another. I also don’t think depression helps matters much. I guess a suicide attempt could be seen as not taking other’s feelings into consideration, but if you knew how much I worried and obsessed over this beforehand you would realise it is not.

8. Envy

is often envious of others or believes others are envious of him or her

I think everyone gets jealous now and again. I can be envious of others that have recovered from illness, because I wonder why I have not. I can be envious when someone gets better grades than me at school. I can be envious when I see people having a great time when I am depressed. I wouldn’t say it is often though and certainly no worse than most.

I really don’t believe anyone is envious of me. There would be no reason to be. I’m depressed. My life sucks!

I hope I don’t, but I guess at times I can be a bit of a snob and I’m guilty of generalisations. I am not exactly appreciative of chavs and I can sometimes be a bit rude towards people that watch rubbish on TV, but I’m not alone on this. I don’t think I’d go as far to say that this is a major problem or that I was particularly bad at it. I certainly know people who are worse than me!

_______________________

Anyway. I’m going to post this now. It’s not really complete. There is plenty more I could say on the matter, but I’ve been at it for hours and if I don’t post it now it may be days before I do finish it. Maybe I will edit this post, or maybe I’ll add another. We shall see. This is well over 3500 words long now and I have spent quite a few hours on it.

Does anyone have any ideas of what to do next? I just feel a bit lost and trapped. I’m worried that if I question the diagnosis, it will come across as narcissistic! That is the biggest problem with personality disorders. Questioning it is just further evidence of the disorder and can all be seen as part of the problem.

I’m updating purely for something to do. I don’t think anything is going to happen today. No visitors and no ward round.

My ward round yesterday was strange. The usual scary NHS experience of a room full of people and not having any idea who most of them were. It’s not like we have any occupation or therapy here so there can’t even be OTs. Unless there were and they just do nothing! I was too nervous and hyper to ask who they were or remember if they told me their names.

I was interviewed by a psych whose job title I cannot remember, but Dr M was there too and interjected now and then. I was so nervous, that mixed with the hypomania, I became pretty incoherent, speaking so fast they were grappling to keep up. I started by trying to lay down my guidelines – respect, not being patronised and being informed. Not sure how much they listened. I was asked and talked about my diagnosis and how it came about, when I first sought help and what happened following, my last admission here, ECT, The Priory, medication and more. I talked so so much in the half hour that I became hoarse and barely stopped for breath. Felt like both hours due to the amount covered and minutes due to speed! At the end they decided that they needed more time to read my notes and discuss before they did anything and suggested that they would call me back in later so they could give me an idea of the plan. I agreed to this.

Sadly later never came. I don’t know if this is because of what happened afterwards. At 1.30 which was my original appointment time my useless social worker, J turned up uninvited and apparently unannounced. I had been asked if I wanted her there and said no, which is why they could change my time to this morning. The nurses seemed to be as confused as I was when she arrived. J saw me and proceeded to wind me up, which as I was already agitated was not helpful at all. She basically suggested I have made bad choices to end up here and it is all my fault. She doesn’t seem to recognise or acknowledge mental illness despite it being her job. She moaned about not going in ward round with me, ignoring the fact I didn’t ask her to come. Apparently it is just what happens. Well no it isn’t if I am asked and say no, surely? She then asked to see the doctor and went in without me. I am angry about this because I explicitly asked to be treated like an adult and be kept informed, but I was not involved in this conversation. I don’t know what was said, but she came out and told me they intend to RE-assess me next week before they decide to write my CPA or do anything. I got the impression I would not be involved in this latter process. She then left saying she will be checking exactly when my next ward round was so she can be there. I didn’t seem to have a choice in this matter and it seems they are generally weekly. No wonder no one gets out very fast with all this waiting to be seen.

I still hoped I would see the doctor again and they would have a plan for me, but it didn’t happen. I fear they decided just to talk to J and not bother with me, despite my wishes.

I am concerned by the mention of reassessment. Surely that is what happened yesterday? Admittedly I was hypomanic so it may not have been as clear as they would like, but for all they know I could be very manic by next week and they can’t reassess me every week before they do anything. I could be here forever. I also worry it means they do not trust or believe me. I have been feeling a little paranoid.

I moaned about J a lot to my bloke when she’d gone and said I wanted to change. He called the CMHT afterwards. Told J’s manager I wasn’t happy and hadn’t been for a while. Apparently they are meeting today to discuss and consider someone else. I’ve not been informed by anyone here about this yet, just by the bloke. Another sign of being ignored.

They asked if I wanted to complain formally. I was unsure about this, but have been encouraged by my bloke to write a letter, which I did last night. It is probably too long, but there have been so many niggling problems, as well as her general attitude, it was hard to express things. That and hypomania leads to verbiosity.

I feel a lot less hyper and giddy this morning and may be starting to come down a little. Kinda in two minds about this. Some of the hypomania has felt pretty good over the last couple days. Writing and writing. Not feeling tired. Things feeling bright and fast. It makes a change to numbing depression. But, and there is a but, I was worried about how I was coming across. It may have been to blame for the lack of response in ward round. I have also worried about things turning really nasty and the background thoughts becoming louder whilst still having this energy. Although my mood is mixed, the hypomania has been dominant meaning it is less bad.

Now I feel a little agitated, but mainly unable to think. Numb and bored. Frustrated. Wish I knew what was happening.

I thought it formatted weirdly when I looked at in my nokia browser, but apparently it is fine. Checked on skyfire and all good. No idea how I tag posts though. Can do that later I guess. (Edit: finally got around to tagging).

So today has been up and down. getting increasingly high all morning, down a bit mid afternoon and going up again now. This daily pattern often happens when I’m hypomanic. Always worst in the evening as night and supposedly sleep approaches. I’m not sure I’m going to need much again tonight. Been trying to stay off the stimulants although I had some haribo.

Spoke to my grandma. Had to consciously try to slow down my speech and I talked and talked and talked. She couldn’t get me off the phone. Oops.

Played some more solo scrabble this afternoon. It is sad that I end up playing myself, but nothing else to do and no one else really up to playing with me.

Filled in my WRAP form. Makes sense, but I know that when crisis comes I am likely to ignore what it says, even though I know I shouldn’t. It is not like I don’t know what I should be doing. It is just that when it comes to doing it I find it so bloody hard to ask for help, or even if I do manage to ask for it, I can’t then accept it. I don’t know. I don’t really remember being well so filling that part in was hard. It was useful to write what recovery means to me though and my early warning sides for both depression and hypomania. I remembered reading Dee Dee’s account of her WRAP plan as I was doing it and had some of the same thoughts (note – must edit to add link when on computer – Edit: Here we go!).

Crap. I just had bad news. Was meant to be seeing the psychiatrist tomorrow, but I’ve just been told it will be Thursday now. I can’t wait that long for change. I need someone to do something. I need a plan so I have some hope. What is the point in me being stuck in here for days without seeing a doctor? That will be almost a week I will have been here without seeing a psychiatrist. Isn’t the point of being here to have constant care from a psychiatrist and to make a plan to get better? The nurse didn’t explain why. Just told me they will explain tomorrow and a mistake has been made. I feel like I’ve been stabbed. I was counting down the hours until tomorrow afternoon and now there are a lot more hours for me to wait. I don’t know what to do. I started to cry, but I can’t even do that properly. Stopped as soon as I started. Froze up like the weather. I just wish I knew what was happening. I wish I didn’t feel so powerless.

I don’t know how long I can take this. I am meant to be here to get better but I just feel cooped up with no support. I don’t see the point. Wonder if I’d be better at home, but even though I’m here voluntarily I suspect they would change that if I tried to leave. I don’t know. I don’t know. I don’t know.

I have no idea if this will work from my mobile email address and not my intothesystem one, but it is worth a try. I am not going to blog much as I guess I should be using my time here to try and get better. At least that is what everyone keeps telling me, but then again I am bored and it helps me to order my thoughts and write. All I have done is write. About 80 sides in my A5 paperchase notebook in 3 days. I am going to run out of space in a few days at this rate. Already using vast quantities of ink!

I think I am a little hypomanic at the moment. My mood has got increasingly speedy over the past 24 hours. It was horribly mixed last night. Desperately suicidal and wanting to self harm, yet bouncy and hyper. This morning I am just hyper and giddy. The bad thoughts aren’t as strong and are being replaced by a constant need to talk and write. I’ve been trying to calm down to avoid the chemical cosh. Avoiding the urge to dance around and sing!

Apparently I will see the psychiatrist tomorrow. I was hoping it would be today. Spoke to one of my named nurses for a bit just now though so they should know what my mood is like. I just about talked her silly I think. I seem to have got lucky with my nurses. They seem to be the two nicest staff here but they are both new, young and not disillusioned yet.

I just want people to be straight with me and tell me what is going on though. There doesn’t seem to be much involvement with the patients. We just get ordered to dinner and to collect our meds and that is about it.

Actually just after moaning my named nurse came back with a WRAP form saying that I should get involved with my CPA as I am clearly capable and enjoy writing. I guess I’m not being treated as a complete imbecile then! I am trying to make it clear I want to be involved and not just bossed about.

I shall sign off now. Don’t want to write a missive and it not work, but if all goes to plan I may write a little bit now and then.

Thanks so much to everyone for their kind messages of support. Especially to those who have texted or tweeted. You are helping to keep me sane! I say sane of course when I’m in a loony bin, but you know what I mean. Take care Xx

I started this post on Monday, but didn’t get time to finish it. It’s now Sunday! I don’t know where my weeks are going. I keep snatching five, ten minutes or so to write, but it takes me half that time to work out where I was before. I keep wishing I could write more, but other things get in the way. I guess more accurately I could say another person gets in the way. My bloke is still not too keen on me spending time on here and that means I usually have to fit it in when he’s not around.

At Creative Remedies on Monday we were asked to write. To write and to keep writing whatever came into our heads for three minutes. I wrote something private, something which I had thought about writing on here for a while. My thoughts were about how I come across at Creative Remedies. I behave like I used to at work and at uni. Friendly, helpful, bright, but hiding how I actually feel. There is a front there that hides the illness. An act. I feel like I have two halves. One outgoing and intelligent, the other ill and flawed. One bright, one dark.

I soon wished I hadn’t have written this. The next step of the exercise was to place our work in a pile on the table. Each one would be passed onto someone else who would then highlight the bits they most liked. The idea was to give us suggestions of how we could turn our stream of conciousness into something a little more creative. I didn’t want to share these inner thoughts. I didn’t want to let anyone in and break down the front. It was made even worse because my notebook is distinctive so whoever got it would know it was mine.

I felt almost sick as I handed over my book. I was given someone else’s piece. Theirs was fairly personal too, but completely anonymous and it gave me no real idea of the context. It didn’t let me in like mine would let someone else in. I was jealous of the guarded nature of their writing.

I could see who had mine. They were writing fervently on my piece. I worried about what they thought. They hesitated to pass it back still writing away. She glanced over at me and mouthed the words “is this yours?”. I had to reluctantly nod as she brought it over to me. Everyone else was scrabbling away at the pile trying to find their own.

I looked at her words. They were kind and expressive, but I still felt a little violated. She had liked my writing, yet I still felt uneasy. She was worried for me. She could feel the sadness and emotion in my words and wanted to comfort me. She later asked me if I was okay. It felt strange and I wasn’t comfortable with her concern. I don’t know that I deserve it.

I know she will never see me in the same light. She is the one person that knows the façade isn’t real. She will look at me with suspicion wondering what is behind the act. Wondering how I really am. I feel like I’ve been found out.

It’s weird how I can write here, knowing anyone could read this, yet I am so uncomfortable. It’s weird how I’m actually considering dropping my anonymity on this blog, yet I didn’t want to drop the act with one person. How would I feel if the same person came along and read all of this? I don’t know.

I don’t know how I really feel about these two sides. I guess in some ways the act shows I am making progress. I can hold myself together in front of people now. I can portray a sense of capability and confidence. I can actually do things and at times I even enjoy them. There have been times in the past year or so when there was no way I could hide anything and enjoyment was a foreign concept. I was a mess, unwell and visibly so. That’s not true any more.

Yet, I am not sure it’s a good thing. I wasn’t well a year ago when I was first admitted to The Priory and I behaved the same in therapy. I was the sensible, level headed, friendly one. I spent more time giving others advice than I did talking about myself. I was the helpful, confident person. People even wondered why I was there. I seemed fine. I wasn’t.

I don’t really like the act. I don’t like its return. I have worked so hard in therapy to break it down. To be more open and honest about how I feel. To be more true to myself. For the therapists at The Priory, I was making progress when I started to talk about myself. I was chastised when I went into helpful, clever mode. I wonder if I should chastise myself when I act like this now.

At times I wonder if the act was what broke me in the first place. The act was a problem before, back when I was at work. I kept going, working harder and harder to hide how I felt. At times fuelled by unidentified hypomania, at other times fuelled by denied depression. I didn’t want to admit I couldn’t cope. I didn’t want to fail. I wanted to be confident and capable and not at mercy of emotions or illness. I drove myself into the ground until I snapped and my world fell apart.

I am worried I will do that again. I have been doing new things and taking on new projects over the past few weeks. I have ideas, I want to do things, I want to be successful. It’s a familiar feeling. My life has been full of periods where I take on new things and projects, but more often than not I take on too much and cannot cope. With hindsight some of these periods can be clearly attributed to hypomania, but others I am less sure. I wonder if it is just my personality. I don’t want to immediately see everything as something to be pathologised, yet I also want to learn from the past. I need to recognise the patterns and change them. I don’t want to keep crashing head first.

I don’t know what my mood is doing at the moment. People ask me how I am and I don’t know how to answer. I’m depressed, yet am I? Yes, the signs of depression are there. I feel numb, empty, suicidal. Negative thoughts, anxiety, paranoia too. The physical signs are out as well. Headaches, insomnia, tiredness. It all points to depression, but it’s not the whole picture. I am excited about new projects, interested in things (albeit not everything), doing stuff. Where is the anhedonia? I don’t think it’s a mixed state either though. Not in a classic way. I am not really sleeping, but I am tired with it. My thoughts race, but no more than is really usual for me. I am a little on the snappy, agitated, quick-to-anger side, but not physically agitated or excessively so. I don’t feel like things are going too fast. yet. I wish my mind would make it’s mind up. I feel almost lost within my mood.

Going back to the topic of anonymity and this blog. I don’t really want to be anonymous any more. I am not ashamed of my illness and I think it’s so important people are open and honest about these things. We can’t break down stigma if we’re too afraid to talk openly about mental health.

I am not even worried about employers googling me. I have no intention to leave my company any time soon. Even if I was looking for a new job, if a company didn’t want to employ me after reading this then I wouldn’t want to work for them anyway. This may limit my career in future, but it’s something I’m willing to take the risk on.

There is a problem though and it’s my family. I am not sure I am willing for them to know how I really feel. I don’t want them to worry. I know my partner reads this already, but with my parents I am even more economical with the truth. I have never been open with them and I’m not sure I’m ready to start. I guess it is doubtful they will ever google me and find this anyway, but it is still a risk.

I realised though recently it’s not even that which is the main problem. It’s actually the stuff about my sexuality I’m most scared about. I thought I was comfortable with it. I thought I’d worked through everything a few years ago when I really went through a crisis of identity. I haven’t. I am fine with coming out knowing the people I am talking to are open minded, but I am not so sure about the rest of the world. More specific I’m not so sure about those closer to me. It doesn’t hurt if some stranger says something horrible, but if it’s someone I know it’s different. I know my mother can be quite homophobic and I suspect her opinions on bisexuality are even worse. I don’t want her to find out. I have always said that she doesn’t need to know and what she doesn’t know won’t hurt her. I suspect other members of my family would be even worse. I just don’t think I can face it.

I realised the other day that I’m not as comfortable as I’d like with my sexuality in general. The other night I was at the pub with a friend and somehow we ended up talking about gay couples. I mentioned a girl I know who used to be in a gay couple and she now goes out with a bloke. She made some comment about him “turning her” and I pointed out that she could be bisexual. She seemed a little taken aback by that and I didn’t know what to say really. It could have been the time to be honest myself, yet I was uneasy with her reaction. I wish I was comfortable enough to be completely “out”, but I guess I’m still not there.

I guess I could always go back and censor myself. I could make any mention of my sexuality private and I’d be safe, yet I don’t want to. I guess I could throw caution to the wind, face my fears and all of that, but I’m not sure I can do. I don’t know what to do.

So it is official. I am being discharged from The Priory by Dr G. I contacted her yesterday about the outcomes of my NHS appointment and her secretary called me back to say she will sort out the discharge paperwork and copy all my notes to send over to the CMHT. I knew it was coming, but it was still a little weird to know the decision has been made and put into action.

I am really going to miss her support. In a couple of days it will be a year since I first met her and a lot has happened in that year. She has been there through everything and has done her best to help. I wouldn’t be here by now if it wasn’t for her. On many an occasion my promise to her to keep going has stopped me acting. I am not going to say I’m grateful for that, because I still wish I wasn’t here, but I am sure my family are grateful.

Mood wise I’ve come back down from last week. Things started to calm down on Friday and by the weekend I was back to numb, monotonous depression. I’m missing the buzz from last week and disappointed that the promise of hypomania hasn’t been fulfilled, but in a way I am glad it is over. Impulsivity is always a real risk when I am wired like that. The flat depression isn’t fun either though. I am so bloody bored of feeling like this. Able to function, but wishing I wasn’t. Stuck in some kinda half-existence, where I go through the motions but feel so little and care even less. In a way it is better to feel worse, because at least then you are feeling something.

Today I was interviewed for local radio. Next week they are focussing on mental health in the run up to World Mental Health day on 10th October. The BBC came to Creative Remedies this afternoon as they want to feature the scheme on one of the shows. I was a little surprised when the staff asked if they could interview me. I had no idea what I was going to say, but managed to get through it and hopefully with a little editing I will sound half-coherent. I’m not quite sure why the outreach team picked me as I’ve not been going for long, but I guess I come across as fairly confident and talkative in sessions, where as a lot of people are quiet and reserved.

The team were asking me about ideas for advertising and improving the scheme. There are a lot of things they could do with it so it will be interesting to see how things go and what suggestions get implemented. They also want to set up a website about the sessions and to have somewhere to display our work. Of course I have experience in that area, so it looks like I’m going to work on that with P, one of the outreach workers. I think the team are quite keen to make use of my skills!

A little less agitated than yesterday evening at the moment, but I’ve had a terrible night’s sleep. I was very wound up all night and couldn’t keep still. My head was flying all over the place. Every time I drifted into sleep I had busy, fast, vivid, strange dreams. I was waking up from them every 30 minutes or so and wondering why I wasn’t doing all the things I was dreaming about and then I couldn’t get back to sleep because my mind was flying off on all these tangents inspired by the dreams. Things eventually seemed to calm down a little around 6-7am, so I did get a couple hours of sleep, but even then my sleep was littered with more dreams.

Part of this agitation may have been exacerbated by the argument I had with my partner last night. The night before I am due to go for an ESA medical, testing whether or not I am fit for work, he tells me I should just go back to work and implies that I am lazy, a skiver and not ill at all. This isn’t helpful.

He was telling me that I should just go back because unless I do, I’ll never be ready. He thinks I am just putting it off forever. He thinks I need to go back and try to work because until I do I can’t be sure if I am ready or not. This is of course true, but I think I need to be showing more signs of being ready before I try it.

There are of course a lot of things to lose by going back too soon and then having to stop working. The loss of my permanent health insurance income being one. I’d have to apply again for it, which is a lengthy process. The loss of ESA will be another factor, if of course they ever give me it. As I am claiming under youth rules I’d have to be off sick for another 6 months before I can claim again.

I suspect that he may in part be pushing me back for selfish reasons. He has of course given up a lot to look after me, but I think it is wearing thin and he doesn’t want to stay at home and care for me any more. I pointed out to him that if I am ready enough to go back to work then he shouldn’t need to care for me anyway and should just go out and get himself another job, but he didn’t seem to agree. The fact he still thinks I can’t be left on my own must tell him I can’t be expected to work. I would likely be on my own a lot in the office and there’s also the matter of getting to and from work. It would be easy to abscond.

My social worker seems to have a strange attitude to my employment. She was asking me if my goal for recovery is to get back to work. For me, the ultimate goal is being well enough to work again and more importantly for me, to go back to the job I loved doing. She seemed disappointed with this and almost surprised. It really felt as if she thought I shouldn’t expect to work again because of my mental health. Maybe she just feels I shouldn’t be working in a high-pressure, highly competitive environment, but for me, working in a simpler job wouldn’t be recovery. It would seem like a poor compromise.

To me her attitude to work seems bizarre. Surely her goal should be for me to return to a normal life, or at least as normal life as possible? I don’t think it should be expected that I will remain disabled and a full-time mental for life? I really fear that will happen and need as much help as possible to stop it happening. I know I have to face the fact that this illness isn’t going to go away and I will have to learn to live with it, but I hope that I will be living a fuller life than this sometime soon.

At the moment I don’t think I’m ready to go back to work. This sudden swing into agitation is a suggestion of that. Last time I tried to return to work I became very hypomanic, very quickly, probably aided by the fluoxetine I was on at the time. Work is likely to fuel this mood and send me up and up. Maybe that would be nice, but I’m not sure I’d be a productive employee.

Even if I hadn’t have entered this mood yesterday, I don’t think I’m ready yet. I am still battling suicidal thoughts almost constantly. Stress would only make these thoughts more urgent and amplify the need to escape this world.

There is also the matter of anger management. I’m not there yet. I have calmed down on a month or two ago, but I am still struggling with bubbling agitation. The smallest thing can send me into rage, wanting to hurt both myself and the cause of the anger. I have to admit I can’t take criticism. It was something I found hard before, but I usually turned it on myself mentally. Lately I’ve been literally hitting back and that is not suitable behaviour for work. I don’t want to be violent and I certainly don’t want to display that in the workplace. It would do nothing for reducing the stigma that mentally ill people are dangerous.

It is these things that I’ll be talking about today at the medical. I need to convince them I shouldn’t be working, yet I’m doubting this myself. I hate being hypocritical. I guess if I do get through the medical it is proof that I shouldn’t be working. If I can convince the DWP, who are notoriously bad at trying to get people back to work before they are ready, then I really must be ill. We will see. I don’t hold my breath.

There is a voice that tells me I am a fraud and I should just go back to work. I feel lazy, sitting around having nothing to do all day. I am trying to occupy myself, but I am not a productive member of society.

I am getting stuff done, but this only makes me think I should be working. Over the past couple of days I’ve embarked on a project to sort out all of my photos and to get them online. I used to have a photo gallery on my website, but I took it down when the domain was up to expire and since uni I’ve been very lazy about my photography. I have literally thousands of images, over 40gb worth. A lot of these are utter rubbish, but I want to find the ones that aren’t and get them out in the open. Anyway, the point of this is I’ve been sitting on my computer sorting this photos out and generally I’ve been able to concentrate on the task in hand. Considering a vast amount of my job is sitting at a computer then maybe I should be doing that and not just sorting out my photos.

I’ve been baking more recently and on Tuesday, I also made a load of home-made chocolates. I managed to do it successfully this time after a recent attempt involved me using semolina instead of sugar. Unsurprisingly the mixture had to go in the bin. They were popular at creative remedies yesterday, with many suggestions of having to sell them or give them as christmas presents.

I had even ventured back into the world of books and reading over the past month or so. I haven’t picked up a book for a couple of weeks, but I was getting there. I was reading stuff and even starting to enjoy it a little. I sometimes had to read paragraphs multiple times or forgot what I had been reading the previous day, but I was getting through the pages.

I also worry about this blog. The fact I can sit here and read and write. Does that mean I should be working instead of just writing about the fact I’m not? If people found this, would they use it against me to tell me I should be working?

This desire to work has of course has been amplified by my mood since yesterday. I have all these ideas of things I could be doing at work. I will not be on a project at first so need to find some internal work I could be doing. I can think of so many ways to improve our company. So many things that could be done and I want to be the person to do them.

There are barriers to returning. My doctors tell me I’m not ready. My social worker tells me I’m not ready. I need to go to occupational health before they will let me go back to work and they may well tell me I’m not ready. When will I know if I’m ready? How can they know?